I. Disclosure. The Detox Stop. READ CAREFULLY - THIS AFFECTS YOUR LEGAL
RIGHTS. This treatment is a process and subsequent visits may be necessary in order to achieve the desired results. Subsequent visits are subject to additional charges per visit, which depend on the amount of work needed. Actual results vary from person to person and The Detox Stop does not guarantee any specific result. The Ultrasound Cavitation treatment carries with it possible health complications and consequences, which include but might not be limited to the risk of kidney failure, liver failure, pacemaker failure, birth defect, miscarriage, thyroid damage, damage to the ovaries, lactation complications, hypertriglyceridemia, hypercholesterolemia, pancreatitis, infection, scarring and/or allergic reaction to any products used, excessive thirst, dehydration, nausea. The Ultrasound Cavitation treatment includes, but is not limited to, the use of high-power low-frequency ultrasound cavitation which uses 25-28KHz frequency ultrasound to penetrate the skin and assist with the breakdown of fat cells by creating micro-bubbles that increase the pressure around the adipocyte and force it to implode, thus breaking down adipocyte’s cell membrane. After Care instructions must be followed explicitly, whether given in writing or orally. Failure to follow aftercareinstructions may compromise the final results of the treatment. I understand that Ultrasound Cavitation is not a substitute for healthy lifestyle choices, such as healthy eating habits and exercise. I further understand and acknowledge that there is no such thing as a “magic” cure for obesity. I understand that the final result of any weight loss effort is profoundly improved with the inclusion of physical activity, increased water intake and lymphatic drainage. Failure to improve my dietary and lifestyle habits will result in future weight gain and a potential need for additional treatments, even after a successful series of initial treatments. I have been advised to refrain from purchasing treatment packages until after I have experienced satisfactory results and I am certain that I want to continue treatment. Before, during and after pictures may be taken to document the treatment. These pictures or videos become The Detox Stop sole property and may only be used for its legitimate business purposes
II. Release.I recognize that there are certain inherent risks associated with the above, described
treatment and I assume full responsibility for personal injury to myself. I attest that I am a healthy, qualified candidate for such treatment to the best of my knowledge. In exchange for such treatment, I hereby fully release and forever discharge The Detox Stop (including its officers, members, owners, employees and agents) from any and all damages, costs, expenses, liabilities, causes of action, claims and demands, of whatever character, in law or in equity, whether known or unknown, direct or indirect, asserted or unasserted, and whether or not on account of myself, The Detox Stop, other third parties, or in any way arising out of the above described treatment I have requested The Detox Stop to perform. I agree to indemnify, hold harmless and defend The Detox Stop (including its officers, members, owners, employees, and agents) against all third-party claims, causes of action, damages, judgments, costs or expenses, including attorneys’ fees and other litigation costs, which may in any way arise from the above described treatment I have requested The Detox Stop to perform.
III. Arbitration. It is understood that any dispute arising as to malpractice of the Ultrasound Cavitation treatment shall be decided by a neutral arbitrator. Any arbitration proceeding will be governed by California’s arbitration statute, the fees for the arbitrator will be split pro-rata among the parties and each party will be responsible for their own attorneys’ fees and costs. Any action to collect fees from the client/patient for the treatments performed may be brought in any court located in California and the prevailing party in such collection action shall be entitled to recover its reasonable attorneys’ fees and costs. Filing of any action in any court to collect any fee from the client/patient shall not waive the right to compel arbitration of any malpractice claim. By signing this agreement, I confirm that I am over the age of 18, I understand that the Ultrasound Cavitation procedure is permanent, that such procedure has possible adverse consequences and that the procedure is for cosmetic purposes only. I certify that I have read the above paragraph’s, had the procedure and risks explained to me, fully understand this consent and procedure form and herebyconsent to the indicated procedure(s). This means that I accept full responsibility for these and/or any other complications, which may arise or result during or following the Ultrasound Cavitation procedure which is to be performed at my request according to this agreement and I hereby agree to arbitration of any malpractice claim.
IV. Fees. The client must reschedule or cancel the appointment 24 hours prior to the start time of the appointment. Any cancellations within 24 hours of appointment start time or no-shows will be charged 50% of the appointment/package fee. All costs are payable in fullprior to initial treatment and are non-refundable. Costs do not include future visits unless expressed otherwise. Must pay for an entire package price on the first visit to receive package discount, unless using a payment plan. Packages, once purchased and treatment initiated, are non-refundable.
V. Term. If the client is late, any time lost will be taken out of the said client’s session time and will notaffect the next client’s appointment